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Value-based Decision-making
Resources for PPOs
For many PPOs the role of the PPO clinical leadership may be to bring best practice information on value in health care purchasing. There is increasing information that benefit design can support best practices in diabetes and other chronic care management. For example, many payers are experimenting (or have results of effectiveness) with approaches that could include patient and provider incentives and new reimbursement models. The goal is to create incentives for payers and providers to adhere to programs to prevent illness or complications, and to avoid services that are not linked to better outcomes.
Payer strategies around could include:
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Focusing on Wellness, including benefit incentives to encourage patients to adopt healthy lifestyles
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Reducing co-pays for essential diabetes-related services and medications
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Covering adherence support services such as counseling by a pharmacist or diabetes educator
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Creating tiered benefits for services based on the value of the services
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Creating tiered networks of providers based on the quality and efficiency of providers
Examples of Value-based Benefit Approaches:
For More Information Visit These Web sites:
The Center for Studying Health System Change (HSC) is a nonpartisan policy research organization. HSC designs and conducts studies focused on the U.S. health care system to inform the thinking and decisions of policy makers in government and private industry. HSC produces data bulletins and issues briefs of relating to health systems reform and benefit design. A recent publication, “Issue Brief: Benefit Design Innovations: Implications for Consumer-Directed Health Care” includes valuable insights on value-based insurance design.
The Center for Value-Based Insurance Design is an academic center that evaluates health care financing approaches and promotes value-based insurance benefit designs. The Center conducts research on value-based insurance design and offers links to research by its own faculty as well as related studies. The Center offers articles on cost sharing, lowering costs and improving benefits. Research focuses on new approaches to patient contribution and effectiveness in health care. Presentations from Center leadership are posted, as are dates for future events.
The Center for Value-Based Health Management helps employers and providers in evaluating health care costs and addressing solutions. Through "FIT Design" the Center advocates for fact-based, integrated and targeted health care to increase the value of patients' benefit designs. The book Total Value, Total Return gives an understanding of value-based health management and is available through a podcast on the Website or by order from a sponsoring organization. Further resources include podcasts, case studies and assessments for providers.
The National Business Group on Health (NBGH) is a non-profit organization offering employers resources for understanding and managing health care concerns in the workplace. The National Business Group on Health provides employers with information on a wide variety of health and benefits topics as well as new developments in health care policy. The diabetes resource page offers materials to employers to increase diabetes awareness and prevention programs in the workplace. NBGH offers the "Purchaser's Guide to Clinical Preventive Services: Moving Science into Coverage", a comprehensive toolkit for employers on preventive health services, including a purchasers' guide, cost-calculators and presentations.
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